Epicardial ablation guidance using coronary arterial models and live fluoroscopic overlay registrations

摘要

Knowledge of patient-specific cardiac anatomy is required for catheter-based ablation in epicardial ablation procedures such as ventricular tachycardia (VT) ablation interventions. In particular, knowledge of critical structures such as the coronary arteries is essential to avoid collateral damage. In such ablation procedures, ablation catheters are brought in via minimally-invasive subxiphoid access. The catheter is then steered to ablation target sites on the left ventricle (LV). During the ablation and catheter navigation it is of vital importance to avoid damage of coronary structures. Contrast-enhanced rotational X-ray angiography of the coronary arteries delivers a 3D impression of the anatomy during the time of intervention. Vessel modeling techniques have been shown to be able to deliver accurate 3D anatomical models of the coronary arteries. To simplify epicardial navigation and ablation, we propose to overlay coronary arterial models, derived from rotational X-ray angiography and vessel modeling, onto real-time X-ray fluoroscopy. In a preclinical animal study, we show that overlay of intra-operatively acquired 3D arterial models onto X-ray helps to place ablation lesions at a safe distance from coronary structures. Example ablation lesions have been placed based on the model overlay at reasonable distances between key arterial vessels and on top of marginal branches.